Holmes D R, Simpson J B, Berdan L G, Gottlieb R S, Leya F, Keeler G P, Califf R M, Topol E J
Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 1995 Nov 15;26(6):1494-500. doi: 10.1016/0735-1097(95)00339-8.
This study sought to assess the incidence and consequences of abrupt closure in a series of patients undergoing directional coronary atherectomy versus percutaneous coronary angioplasty.
Abrupt closure with coronary angioplasty has been associated with adverse outcome. The results from the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) I, a randomized trial of coronary angioplasty versus directional coronary atherectomy, were analyzed.
This multicenter trial enrolled 1,012 patients from 1991 to 1992. All records from patients with abrupt closure, which was coded as a discrete complication, were reviewed.
Abrupt closure occurred in 60 patients (5.9%) and was associated with a significantly longer hospital stay (median 8 vs. 3 days). Severe proximal target vessel tortuosity was more common in patients with abrupt closure (20.3% vs. 11.6%, p = 0.046), as was preexistent coronary artery thrombus (30.5% vs. 18.3%, p = 0.02). Abrupt closure was associated with a marked increase in subsequent complications (myocardial infarction 46.7% vs. 2.1%, emergency bypass surgery 38.3% vs. 0.32%, death 33% vs. 0%) and occurred more frequently in the directional coronary atherectomy group (8.0% vs. 3.8%, p = 0.005). In the coronary angioplasty group, the occlusion usually occurred at the target lesion (91%), presumably related to the effects of barotrauma. In the directional coronary atherectomy group, the site of the occlusion was the target lesion in only 58% (p = 0.045). The remaining occlusions related to problems with the technique (guide catheter or nose cone trauma), reflecting the fact that directional coronary atherectomy is a more complex procedure.
Abrupt closure remains the principal determinant of adverse outcome after percutaneous procedures for the treatment of coronary artery disease. Although abrupt closure is more common with directional atherectomy than angioplasty, the sequelae are similar.
本研究旨在评估接受定向冠状动脉斑块旋切术与经皮冠状动脉腔内血管成形术的一系列患者中突然血管闭塞的发生率及后果。
冠状动脉腔内血管成形术导致的突然血管闭塞与不良预后相关。对冠状动脉腔内血管成形术与切除性斑块旋切术试验（CAVEAT）I（一项冠状动脉腔内血管成形术与定向冠状动脉斑块旋切术的随机试验）的结果进行了分析。
这项多中心试验在1991年至1992年期间纳入了1012例患者。对所有记录为离散并发症的突然血管闭塞患者的记录进行了审查。
60例患者（5.9%）发生突然血管闭塞，且住院时间显著延长（中位数8天对3天）。严重的近端靶血管迂曲在突然血管闭塞患者中更为常见（20.3%对11.6%，p = 0.046），既往存在冠状动脉血栓的情况也是如此（30.5%对18.3%，p = 0.02）。突然血管闭塞与随后并发症的显著增加相关（心肌梗死46.7%对2.1%，急诊搭桥手术38.3%对0.32%，死亡33%对0%），且在定向冠状动脉斑块旋切术组中发生频率更高（8.0%对3.8%，p = 0.005）。在冠状动脉腔内血管成形术组中，闭塞通常发生在靶病变处（91%），推测与气压伤的影响有关。在定向冠状动脉斑块旋切术组中，仅58%的闭塞发生在靶病变处（p = 0.045）。其余闭塞与技术问题（导引导管或枪头损伤）有关，这反映了定向冠状动脉斑块旋切术是一种更复杂的手术这一事实。
突然血管闭塞仍然是经皮治疗冠状动脉疾病术后不良预后的主要决定因素。虽然突然血管闭塞在定向斑块旋切术中比在血管成形术中更常见，但其后遗症相似。
